| NPI | 1073742425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA DO.000309) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: LA DO.000309) |
| 207P00000X Emergency Medicine (Licence: LA DO.000309) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: LA DO.000309) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2019-09-09 |